Background: Numerous healthcare services have been affected by the COVID-19 pandemic worldwide. Specialized healthcare services were postponed or canceled, potentially compromising regular services for hemato-oncology patients. The current study aimed to analyze the impact of the COVID-19 pandemic on access to hemato-oncology services in Almaty, the largest city in Kazakhstan. Methods: We retrospectively analyzed the socio-demographic characteristics of patients admitted to two large tertiary centers rendering hemato-oncology services, the City Clinical Hospital 7 (H7) and the Kazakh Institute of Oncology and Radiology (KazIOR). All data were retrieved for the period spanning from 1 March 2019 to 28 February 2022. The retrieved variables included age, gender, type of residence, hospitalization rate, treatment outcomes (discharged/deceased), bed days, diagnoses according to International Classification of Diseases (ICD-10) (acute leukemia and hematopoietic depression, lymphoproliferative diseases, and myeloproliferative diseases), and referral sources (ambulance, another hospital, consultative and diagnostic assistance, primary healthcare, self-referral, and referrals from hematologists’ offices). Results: In the 2019–2022 period, 6763 hemato-oncology hospitalizations were registered: 3583 in H7 and 3180 in KazIOR. The mean age at hospitalization was 55.04 (SD = 16.07) for females and 51.2 (SD = 16.7) for males. The proportion of hospitalized urban and rural patients differed significantly: 6191 (92%) and 571 (8,4%), respectively (χ² = 13.8, p = 0.001). In the 2020–2021 period, fewer patients were discharged (n = 2047) compared to 2019–2020 (n = 2387) and 2021–2022 (n = 2081) (χ² = 20.09, p = 0.003). However, the proportion of deaths in the 2020–2021 period (3.5%) was higher than in the 2019–2020 (3.2%) and 2021–2022 periods (2.6%) (χ² = 20.09, p = 0.003). A total of 403 (19%) hospital admissions were carried out by ambulance (emergency cases) in the 2020–2021 period, 368 (14.8%) in 2019–2020, and 394 (18.3%) in 2021–2022 (χ² = 2231, p < 0.001). The number of patients transferred from other hospitals to H7 and KazIOR increased by 12.4% in the 2020–2021 period. Conclusions: Our findings indicate a negative impact of the COVID-19 pandemic on access to hemato-oncology services, leading to increased mortality. Further studies are warranted to explore factors underlying the trends in hospitalizations and mortality of hemato-oncology patients during healthcare crises.

Relevance. The COVID-19 pandemic placed unprecedented pressure on hospital systems, exposing structural vulnerabilities in resources, governance, and workforce capacity. In Kazakhstan, particularly in Almaty, major system reorganizations, including modular COVID-19 hospitals, were implemented; however, qualitative data on healthcare managers’ views on their effectiveness and preparedness for future challenges remain limited. Objective: This study aims to explore healthcare managers’ experiences of hospital functioning during the COVID-19 pandemic in Almaty, assess the perceived effectiveness of implemented measures, and identify key factors influencing preparedness and resilience for future pandemics. Materials and Methods. A qualitative study design was employed using semi-structured in-depth interviews. Sixteen healthcare managers (5 senior-level and 11 mid-level) from multidisciplinary hospitals in Almaty were recruited through purposive sampling via professional WhatsApp groups. Data were collected in the first quarter of 2026 through online interviews lasting 15-20 minutes. Interviews were audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis. Results. Seven interrelated topics were identified: (1) hospital overload as a manifestation of systemic unpreparedness; (2) resource constraints, with oxygen infrastructure as a critical bottleneck; (3) modular COVID-19 hospitals as a key adaptive strategy; (4) the importance of timely and coordinated organizational responses; (5) workforce well-being as a core determinant of system performance; (6) partial preparedness for future pandemics; and (7) the need for an integrated and adaptive preparedness system. Modular hospitals were perceived as a turning point in the pandemic response, improving capacity and system coordination. Despite improvements, persistent challenges related to workforce shortages, governance, and digital infrastructure remain. Conclusion. Hospital system performance during the COVID-19 pandemic was shaped by the interaction of resources, governance, and workforce resilience. The findings highlight the need for integrated and adaptive health system approaches, including scalable infrastructure, strengthened workforce policies, improved governance, and enhanced digital systems, to ensure preparedness for future public health emergencies.

The COVID-19 pandemic has caused substantial health and economic impacts worldwide. However, evidence on the economic burden of COVID-19 hospitalizations in Central Asia remains limited. This study aims to estimate the economic burden of COVID-19 hospitalizations in the Almaty metropolitan area from both healthcare system and societal perspectives between 2020 and 2022. Administrative hospital data were used to analyze all COVID-19 hospitalizations in Almaty during 2020–2022. Direct medical costs were estimated from the healthcare system perspective using standardized reimbursement tariffs from Kazakhstan’s Mandatory Social Health Insurance system. Indirect costs were estimated from a societal perspective using the human capital approach to quantify productivity losses due to hospitalization, recovery, and premature mortality. Sensitivity analyzes the effects of variations in wage levels, discount rates, and medical costs. Older adults (≥65 years) experienced the highest burden of severe outcomes, accounting for the largest share of ICU admissions and deaths. The number of hospitalized patients increased sharply in 2021, accompanied by longer hospital stays and higher healthcare resource utilization. The total economic burden peaked in 2021 at $258.0 million, driven by increased hospitalizations, ICU utilization, and productivity losses associated with hospitalization, recovery, and premature mortality. Sensitivity analysis showed that overall cost estimates were robust to variations in discount rates, while wage assumptions moderately influenced indirect cost estimates. COVID-19 hospitalizations impose a substantial economic burden on both the healthcare system and society in Almaty, particularly during the 2021 pandemic peak. Strengthening early public health interventions and improving real-time health data systems may help optimize resource allocation and enhance preparedness for future health crises.

Background/Objectives: Chronic kidney disease (CKD) is a recognised risk factor for severe COVID-19, but comparative outcomes between conservatively managed CKD patients and those on maintenance haemodialysis (HD) remain incompletely characterised, particularly in Central Asia. This study evaluated the impact of CKD severity on clinical outcomes, inflammatory profiles, and mortality in hospitalised COVID-19 patients. Methods: This retrospective cohort study reviewed 891 patients hospitalised with COVID-19 at a tertiary infectious disease centre in Almaty, Kazakhstan, between 2020 and 2021. Patients were stratified into three groups: No CKD (n = 598), CKD without HD (n = 116), and CKD on maintenance HD (n = 177). Demographic, laboratory, treatment, and outcome data were extracted from electronic medical records. Multivariate logistic regression was used to identify independent predictors of in-hospital mortality, acute kidney injury (AKI), and intensive care unit (ICU) admission. Model 1 served as the primary prognostic model, while Model 2 explored in-hospital complications. Results: Patients with CKD exhibited significantly higher inflammatory markers, with peak C-reactive protein reaching 168.3 mg/L in the HD group compared to 44.4 mg/L in the No CKD group. In-hospital mortality was highest in the CKD without HD group (34.8%), followed by CKD on HD (21.7%) and No CKD (13.6%). AKI occurred in 35.7% of conservatively managed CKD patients. In multivariate analysis, CKD without HD independently predicted mortality (OR 3.23; 95% CI 1.38–7.63) and AKI (OR 4.12; 95% CI 1.73–10.03). Conversely, established HD status was not a significant independent predictor of mortality after adjusting for age and comorbidities. Conclusions: CKD severity strongly influences COVID-19 prognosis. Paradoxically, conservatively managed CKD patients carry a higher mortality and AKI risk than patients already on maintenance HD, which may be associated with the absence of scheduled volume and metabolic control, although causal inferences cannot be drawn from this observational data. These findings support the need for aggressive monitoring and early nephrological intervention in non-dialysis CKD patients hospitalised with severe viral respiratory infections.

The COVID-19 pandemic significantly disrupted inpatient healthcare systems worldwide, leading to rapid reorganization of hospital capacity, patient flows, and resource allocation. Urban healthcare systems were particularly affected due to high population density and increased demand for services. Objective: To assess changes in the performance of inpatient healthcare services in Almaty from 2017 to 2025, with a focus on differences between pre-pandemic, pandemic, and post-pandemic periods. Methods. A retrospective observational study was conducted using aggregated annual data from inpatient healthcare facilities in Almaty. Key indicators included hospitalizations, bed capacity, average length of stay (ALOS), in-hospital mortality, bed occupancy, workload indicators, patient routing, and quality measures. The study period was divided into three phases: pre-pandemic (2017–2019), pandemic (2020–2022), and post-pandemic (2023–2025). Descriptive statistics, one-way ANOVA, and linear regression analysis were applied to assess temporal trends and differences between periods. Results. Hospitalizations increased by approximately 33% from the pre-pandemic to post-pandemic period. Bed capacity expanded during the pandemic and remained elevated thereafter. ALOS decreased over time, indicating improved efficiency. In-hospital mortality increased during the pandemic and declined below pre-pandemic levels in the post-pandemic period. Bed occupancy showed a temporary decline followed by recovery. The pandemic led to a substantial redistribution of bed capacity, with a marked increase in infectious beds. Hospital workload increased significantly, while patient routing shifted toward outpatient referrals. Complication rates declined consistently, indicating improvements in quality of care. Conclusions. The COVID-19 pandemic acted as a catalyst for structural transformation of inpatient healthcare services in Almaty. The post-pandemic period was characterized by recovery, improved efficiency, and enhanced quality of care. These findings highlight the importance of strengthening health system resilience and optimizing resource allocation to sustain long-term improvements.